Date Sent/Mailed: 10/04/2021 Date Sent/Mailed: 10/05/2021 Date Sent/Mailed: 10/14/2021

ADMISSION, REVIEW, AND DISMISSAL (ARD) MEETING INVITATION

Frisco ISD
5515 Ohio Drive
Frisco, TX 75035
P: 469-633-6900

INVITATION TO THE MEETING RE: Ashley Dayanna Gutierrez- School: Emerson High School
Narvaez
Date of Birth: 11/20/2006

To the Parent/Guardian of:

Ashley Dayanna Gutierrez-Narvaez

Additional Invitations to be sent to:

☒ To the student (age 13-17)

You are notified of an admission, review, and dismissal (ARD) committee meeting to discuss your educational
programming or that of your child. We encourage you to attend this meeting, as your involvement is an
important part of the planning process.

Date: 10/15/2021 Time: 09:15 AM Room: Virtual Place: Zoom Call

Purpose of Meeting

☒ Discuss, at your request, any educational or related service not proposed below

☒ Review your child's program (including results of any new evaluations)

☒ Develop and/or review the Individual Education Program (IEP) for your child

☒ Consider ESY (Must address annually)

☒ Consideration of Postsecondary Goals and Transition Services

☒ Discuss transfer of rights at age of majority

The following persons have been asked to attend the meeting:

☒ Parent

☒ Student

☒ Special Ed Teacher/Provider of the student

☒ General Education Teacher of the student

☒ Counselor

☒ District representative

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 Frisco ISD
5515 Ohio Drive
Frisco, TX 75035
P: 469-633-6900

☒ Career and Technical Education Representative

☒ Assessment personnel

☒ Other: Interpreter-Translator
Santiago Castillo

Any other individual(s) with knowledge or special expertise regarding the student may be invited to attend this meeting
by parent/adult student and/or the District, including related services personnel as appropriate. The determination of
knowledge and special education expertise of the individual(s) shall be made by the one (parent/adult student/district)
who invited the individual(s) to the meeting.

The parent(s) of a student with a disability/adult student has protection under the procedural safeguards of the IDEA.
A copy of the procedural safeguards in understandable language where feasible must be given to the parents/guardian
of a child with a disability only once in a year. A copy must also be given when an initial evaluation or a parent request
for an evaluation occurs, upon receipt of the first due process or State complaint during a school year, when the district
decides to make a change in placement due to a discipline issue, and upon parent request. [ 300.504(a)]

A copy will be/was provided to Parent on 10/15/2021

For questions, contact: Jim McDougle Phone: 469-633-8136 Email: [email protected]

Understandable Language
If the native language or other mode of communication of the parent/adult student is not a written language:

☒ The Invitation of ARD was sent in the parent/adult student's understandable language Spanish

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 Frisco ISD
5515 Ohio Drive
Frisco, TX 75035
P: 469-633-6900

INVITATION TO THE MEETING RE: Ashley Dayanna Gutierrez- School: Emerson High School
Narvaez

PLEASE RETURN THIS PAGE TO:

Rita Tebcherany, Special Education Clerk
6300 Collin McKinney Pkwy.
McKinneyTX 75070

Please check the appropriate statement below:

☐ I agree with the proposed date and time and will attend the meeting on 10/15/2021 at 09:15 AM

☐ I would like to attend the meeting, but cannot do so at the time suggested; please contact me at
to reschedule.
☐ I will not attend the meeting: Please have it without me. I want to be notified of the results of the meeting.

☐ I will not be able to attend the meeting in person, but would like to participate via telephone. Please contact me at
at the scheduled meeting time.
☐ I will not be able to attend the meeting in person, but would like to participate virtually. Please email me at
with the meeting information.
☐ I waive the required five school day waiting period between Invitation of ARD Committee Meeting and the ARD
committee meeting.
☐ I am a parent of a three or four year old child and I will be inviting their child care provider to the ARD.

☐ I plan to bring (name) , (relationship/position) to the ARD

meeting with me.

Signature of Parent(s), Guardian, Surrogate or Adult Student Date

Signature of Interpreter, if used Date

Record of contact attempts:

Rita Tebcherany Special Education Clerk
Staff Person Position

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 Frisco ISD
5515 Ohio Drive
Frisco, TX 75035
P: 469-633-6900

1. 10/04/2021 ☒ ☐ ☐ ☒ 1st Notice-Annual ARD

Date Email Phone US Mail Student Results/Outcome
2. 10/05/2021 ☒ ☐ ☐ ☒ 2nd Notice-Annual ARD
Date Email Phone US Mail Student Results/Outcome
3. 10/05/2021 ☒ ☐ ☐ ☐ signed Annual ARD 10-05-2021
Date Email Phone US Mail Student Results/Outcome
4. 10/07/2021 ☒ ☐ ☐ ☒ assigned a Interpreter-Santiago Castillo-10-7-2021
Date Email Phone US Mail Student Results/Outcome
5. 10/14/2021 ☒ ☐ ☐ ☒ 3rd Notice Reminder only-No action required
Date Email Phone US Mail Student Results/Outcome
6. ☐ ☐ ☐ ☐
Date Email Phone US Mail Student Results/Outcome
Documentation/Comments:
Emailed parent 9/14/20. Parent agreed to date/time 9/17/20.
1st Notice of annual 9/18/20.
2nd Notice of annual 9/30/20.

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 Frisco ISD
5515 Ohio Drive
Frisco, TX 75035
P: 469-633-6900

RECEIPT FOR EXPLANATION OF PROCEDURAL SAFEGUARDS OF A PARENT WITH A

CHILD WITH DISABILITIES IN SCHOOL as Required by Individuals with Disabilities Education Act
(IDEA) 34 Code of Federal Regulations - Part 300
AND
A Guide to the Admission, Review and Dismissal Process as Required by Texas Education Code §26.0081

Name of Student: Ashley Gutierrez-Narvaez Date of Birth: 11/20/2006 Date Issued: 10/04/2021

This is to verify that I have received: I understand that my rights include the right to receive:

A copy of the Notice of Procedural Safeguards: This and all other notices in the language I understand (primary
Rights of Parents of Students with Disabilities language) or, if needed, a translation of such orally, in sign
which informs me of my rights throughout the child/ language, or in Braille as appropriate; and answers from school
student-centered educational process. The personnel to additional questions I may have. My signature below
procedural safeguards have been explained to me indicates that I initially received a copy of the Notice of Procedural
by (name/position/date entered in the first column Safeguards: Rights of Parents of Students with Disabilities on the
of each section). date specified and that I understand its contents.
A copy of the A Guide to the Admission, Review
and Dismissal Process which explains the process
by which an individualized education program (IEP)
is developed and the rights and responsibilities of a
parent concerning the process.

Name of Parent, Guardian, Surrogate Signature of Parent(s), Guardian, Surrogate or Date

Parent or Adult Student Adult Student

Name of Interpreter, if used Signature of Interpreter, if used Date

Name of School Staff Position

Emerson High School

Current School Campus

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 Frisco ISD
5515 Ohio Drive
Frisco, TX 75035
P: 469-633-6900

Ashley Gutierrez-Narvaez 228277 Emerson High School 11/20/2006

NAME OF STUDENT ID# MEDICAID# CAMPUS DATE OF
BIRTH

Written Annual Notification to Access Public Benefits or Insurance (e.g., Medicaid)

Medicaid services provided by school districts in Texas to Medicaid-eligible students are known as School Health and Related
Services (SHARS). SHARS allows local school districts, including public charter schools, to obtain Medicaid reimbursement for
certain designated health-related services documented in a student's Individualized Education Program (IEP).

The main objective of the SHARS program is to reduce the cost of delivering health-care services in the school setting.
Services received at school do not affect or compromise the type or amount of Medicaid services received outside of school.
Further, Frisco ISD:
A. Will not require parents to sign up for or enroll in public benefits or insurance programs in order for their
child to receive a free and appropriate education (FAPE);
B. Will not require parents to incur an out-of-pocket expense such as the payment of a deductible or co-pay
amount incurred in filing a claim for services provided;
I also understand that TX Medicaid Instituted TPL (Third Party Liability) policy requirement using the "pay and recover"
method. Using the pay and recover TPL (Third Party Liability) process for SHARS means that Medicaid pays the
school district for services before third party reimbursement is sought. If the third party insurance denies a claim for an
acceptable reason, no further action is taken. Lifetime benefits of private insurance could be affected depending on the
policy or agreement parents or guardians have with the Insurance Company.
Frisco ISD has previously notified and received parental consent to disclose personally identifiable information to the agency
responsible for the administration of the State's public benefits or insurance program (e.g., Medicaid) for reimbursement under
the SHARS program. This information includes but is not limited to name, date of birth, Social Security number, Medicaid
number, date of service, service type and service duration. This form has been provided in language understandable to the
general public and in the native language or other mode of communication used by the parent, unless it is clearly not feasible
to do so. Consent may be withdrawn at any time. A parent's withdrawal of consent or refusal to allow consent does not relieve
the district of its responsibility to ensure that all required services are provided at no cost to the parent(s).

(Consistent with 34 CFR §300.154(d)(2)(v); 34 CFR §300.503(c); 34 CFR §300.154(d)(2)(l)(iii); §300.154(d)(2)(iv)(A)-(B); §300.154(d)(2)
(iv); 34 CFR part 99 & 300)

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